How Perpetrators Make Themselves the Vicitms: "Deny, Attack, and Reverse Victim and Offender" (DARVO)

It's a well-known feature of perpetrators that they generally deny what they have done, attack the accusers (often attempting to destroy their character), and then reverse the situation so that they claim to be the victims.

If you have any doubt about this, look closely at EVERY situation in which Marc Gafni has been accused of sexually inappropriate relationships with his students (often two or more at a time), which includes forcing them to lie about the relationships and controlling their contact with others outside his circle of trust.

Psychologist Jennifer J. Freyd, at the University of Oregon, has detailed this behavior in a model she calls DARVO = Deny, Attack, and Reverse Victim and Offender. What follows comes from her web page on this topic. Freyd is one of the world's experts on betrayal trauma.

Her books include:

• Blind to Betrayal: Why We Fool Ourselves We Aren't Being Fooled (2013)
• Betrayal Trauma: The Logic of Forgetting Childhood Abuse (1998, reprint edition)

Citation:
Freyd, J.J. (2014). What is DARVO? Retrieved 5.28.2015 from http://pages.uoregon.edu/dynamic/jjf/defineDARVO.html.

What is DARVO?

Jennifer J. Freyd, University of Oregon

Short Definition

DARVO refers to a reaction perpetrators of wrong doing, particularly sexual offenders, may display in response to being held accountable for their behavior. DARVO stands for "Deny, Attack, and Reverse Victim and Offender." The perpetrator or offender may Deny the behavior, Attack the individual doing the confronting, and Reverse the roles of Victim and Offender such that the perpetrator assumes the victim role and turns the true victim -- or the whistle blower -- into an alleged offender. This occurs, for instance, when an actually guilty perpetrator assumes the role of "falsely accused" and attacks the accuser's credibility or even blames the accuser of being the perpetrator of a false accusation. 

Disclaimers

• DARVO as a concept is based on observation and analysis. The author has not completed systematic empirical research testing the coherence or frequency of DARVO. However, research is currently in progress in the author's laboratory at the University of Oregon.
• Other observers have likely noted the same phenomena and related phenomena using different terms; the author has been informed that some people have found the term DARVO a helpful mnemonic and organizing concept.
• Also the presence of DARVO is not necessarily evidence in support of the accusation of guilt; a truly innocent person may deny an accusation, attack the person making the accusation, or claim the victim role. Future research may be able to determine the probability of a DARVO response as a function of guilt or innocence. The author hypothesized that some sorts of denials and reactions such as DARVO are more likely when the perpetrator is guilty than innocent (Freyd, 1997); however this hypothesis has not yet been tested. Furthermore, even if research indicates that a DARVO reaction is more likely when there is actual guilt, it would be an error to use a DARVO reaction as proof of guilt.
• For now the concept of DARVO is offered as potentially memorable and useful term for anticipating the behavior of perpetrators when held accountable, and for making sense of responses that may otherwise be confusing (particularly when victim and offender get reversed). Research is needed.

History of Terminology & Writings about DARVO

Jennifer Freyd introduced the term "DARVO" near the end of a 1997 publication about her primary research focus, "betrayal trauma theory." (For more on betrayal trauma theory, see http://pages.uoregon.edu/dynamic/jjf/defineBT.html.)

The reference for the 1997 article introducing the term is:

Freyd, J.J. (1997) Violations of power, adaptive blindness, and betrayal trauma theory. Feminism & Psychology, 7, 22-32.

In that paper Freyd explained that DARVO responses may be effective for perpetrators. "...I have observed that actual abusers threaten, bully and make a nightmare for anyone who holds them accountable or asks them to change their abusive behavior. This attack, intended to chill and terrify, typically includes threats of law suits, overt and covert attacks on the whistle-blower's credicility, and so on..... [T]he offender rapidly creates the impression that the abuser is the wronged one, while the victim or concerned observer is the offender. Figure and ground are completely reversed... The offender is on the offense and the person attempting to hold the offender accountable is put on the defense." (Freyd, 1997, p 29-30)

These ideas were further developed in an article by Veldhuis and Freyd (1999):

Veldhuis, C. B., & Freyd, J. J. (1999). Groomed for silence, groomed for betrayal. In M. Rivera (Ed.), Fragment by Fragment: Feminist Perspectives on Memory and Child Sexual Abuse (pp. 253-282). Charlottetown, PEI Canada: Gynergy Books.

In the 1999 article Veldhuis and Freyd explore the separate components of DARVO, and they also note a connection between DARVO and "betrayal blindness," a concept from betrayal trauma theory (Freyd, 1996).

"By denying, attacking and reversing perpetrators into victims, reality gets even more confusing and unspeakable for the real victim. .... These perpetrator reactions increase the need for betrayal blindness. If the victim does speak out and gets this level of attack, she quickly gets the idea that silence is safer." (Veldhuis & Freyd, 1999. p 274).

Since then the concept of DARVO has appeared in various writings, the most significant of which is our new book Blind to Betrayal (Freyd & Birrell, 2013).

 
Blind to Betrayal: Why We Fool Ourselves We Aren't Being Fooled

In Blind to Betrayal we urge institutions to cherish the whistle blower (see p. 173) and we offer suggestions for specific steps institutions can take to prevent and repair institutional betrayal. In Blind to Betrayal we also talk about institutional denial which plays such a crucial role in instutional betrayal. DARVO is a particularly pernicious form of denial (see p 119 of Blind to Betrayal).
Two Common Types of Denial

Two common forms of perpetrator (or bystander) denial are:

1. It didn't happen (an instance) or It rarely happens (a type of event)
2. It wasn't harmful

Put together they can take the form: "It didn't happen, but if it did, it wasn't that bad" or "It rarely happens, but when it does it isn't harmful." The two claims both serve to deny, but they depend upon different sorts of evidence. They may both be true, but they are sometimes somewhat suspicious when claimed simultaneously (or by the same person at different times), as for instance can occur in response to allegations of rape or child sexual abuse.

Psychosocial Stress, Inflammation, and Adhesion Molecules

I have been re-reading a book by Joseph LeDoux (NYU), Synaptic Self: How Our Brains Become Who We Are (2002), in which he argues that synapses in the brain are the foundation of personality, the basis of our sense of self:

My notion of personality is pretty simple: it‟s that your “self,” the essence of who you are, reflects patterns of interconnectivity between neurons in your brain. Connections between neurons, known as synapses, are the main channels of information flow and storage in the brain. Most of what the brain does is accomplished by synaptic transmission between neurons, and by calling upon the information encoded by past transmission across synapses. (p. 3-4)

This is relevant to some of the work I have been doing for Dr. Cress at the University of Arizona Cancer Center. Dr. Cress has been working for many years on the function of integrins in cancer metastasis, specifically in prostate cancer.

Here is how integrins are defined at Wikipedia, which is as precise as any you will find.

Integrins are transmembrane receptors that are the bridges for cell-cell and cell-extracellular matrix (ECM) interactions. When triggered, integrins in turn trigger chemical pathways to the interior (signal transduction), such as the chemical composition and mechanical status of the ECM, which results in a response (activation of transcription) such as regulation of the cell cycle, cell shape, and/or motility; or new receptors being added to the cell membrane. This allows rapid and flexible responses to events at the cell surface, for example to signal platelets to initiate an interaction with coagulation factors.

There are several types of integrins, and a cell may have several types on its surface. Integrins are found in all metazoa.^[3]

Integrins work alongside other receptors such as cadherins, the immunoglobulin superfamily cell adhesion molecules, selectins and syndecans to mediate cell–cell and cell–matrix interaction. Ligands for integrins include fibronectin, vitronectin, collagen, and laminin.

Integrins are heterdimic adhesion receptors, meaning they have two different parts, the α (alpha) and β (beta) subunits. There are at least 18 α and eight β subunits are known in humans and other vertebrates (Takada, Ye, & Simon, 2007).

Dr. Cress has been work with the A6B4 integrin (alpha 6 beta 4) and its role in metastatic prostate cancer. A6 is one of three laminin-binding molecules in humans (the others are A3 and A7), although other researchers suggest there are five laminin-binding integrins, A1, A2, A3, A6, A7 (Alberts, Johnson, & Lewis; 2007; Molecular Biology of the Cell. 5th edition). This graphic explains the functions of the different integrins and their combinations.

Integrins are also expressed in the brain, especially in synapses and in the lamination of axons, which allows information to more quickly and efficiently through the brain (and through neural cells throughout the body). Schwann cells in peripheral nerves interact with axons and extracellular matrix (ECM) as part of their work in ensheathing and myelinating axons and they express B4 (beta 4 integrin) [Feltri, et al, 1994], and specifically A6B4. 

In digging around for additional information on synapses and brain function, I found a related article by LeDoux - this is the abstract (crucial section is in bold):

STRUCTURAL PLASTICITY AND MEMORY
Raphael Lamprecht and Joseph LeDoux

Much evidence indicates that, after learning, memories are created by alterations in glutamate-dependent excitatory synaptic transmission. These modifications are then actively stabilized, over hours or days, by structural changes at postsynaptic sites on dendritic spines. The mechanisms of this structural plasticity are poorly understood, but recent findings are beginning to provide clues. The changes in synaptic transmission are initiated by elevations in intracellular calcium and consequent activation of second messenger signalling pathways in the postsynaptic neuron. These pathways involve intracellular kinases and GTPases, downstream from glutamate receptors, that regulate and coordinate both cytoskeletal and adhesion remodelling, leading to new synaptic connections. Rapid changes in cytoskeletal and adhesion molecules after learning contribute to short-term plasticity and memory, whereas later changes, which depend on de novo protein synthesis as well as the early modifications, seem to be required for the persistence of long-term memory.

Source: Nature Reviews Neuroscience; January 2004; 5(1):45-54. doi:10.1038/nrn1301 

Rho GTPaseas mediate extracellular stimulation-induced actin cytoskeleton rearrangements. Stimulation of the postsynaptic neuron leads to actin-dependent morphological changes mediated by Rho GTPases105–108. 1) Activation of adhesion molecules, such as integrin or cadherin, which have been shown to be involved in synaptic plasticity, regulates Rho GTPase inactivation by RhoGAPs. 2) Calcium influx through membrane channels can induce activation of tyrosine kinases (TKs), such as the cell adhesion kinase-β/proline-rich tyrosine kinase 2 (CAKβ/Pyk2), that in turn activate Src. The later modulates p190 RhoGAP activity and thereby controls Rho GTPase inactivation. 3) On the other hand, Rho GTPase activators, RhoGEFs, are also regulated by extracellular stimulation. Ephrin A activates, through the receptor tyrosine kinase EphA, a Rho GEF called ephexin. EphA has been implicated in memory formation133. 4) Rho GTPase controls actin polymerization through downstream effectors such as Rho-associated kinase (ROCK). ROCK activates LIM-domain-containing protein kinase (LIMK), which in turn inhibits the actin depolymerizing factor cofilin. This event can contribute to actin polymerization. ROCK, LIMK and cofilin have been shown to be involved in synaptic plasticity. 5) Cdc42 and Rac, other members of the Rho GTPase family, induce actin polymerization by regulating downstream effectors. GAP, GTPase-activating protein; GEF, guanine nucleotide exchange factor; N-WASP, neuronal Wiskott-Aldrich syndrome; SCAR, suppressor of cAR.

The text above is the caption for the image. Here is another quote from near the end of the paper, which is minimal and could be the topic of an entire paper:

Adhesion molecules and synaptic plasticity 

The formation of new synaptic contacts is a dynamic process that involves ongoing morphological alterations and modulation of adhesion between the pre- and postsynaptic neurons [115,116]. These processes require coordinated activity between molecules that regulate cytoskeletal rearrangements and morphology, and those that control adhesion between the pre- and postsynaptic membranes.Adhesion molecules, mostly integrins, cadherins, neurexin and the immunoglobulin superfamily, are membrane-bound molecules that have hetero- or homophilic interactions with proteins in the extracellular matrix and synaptic membranes to control the adhesion between the pre- and postsynaptic membranes. Adhesion molecules, which also have an intracellular component, can initiate signalling pathways that couple the dynamics of extracellular connectivity with intracellular events that control morphology. For example, cadherin regulates dendritic spine morphogenesis and function. Blockade of cadherin function leads to elongation of the spine, bifurcation of its head structure and alterations in the distribution of postsynaptic proteins [117]. Moreover, neuronal activity induces the movement of β-catenin (which mediates the interaction of cadherin with the actin cytoskeleton) from dendritic shafts into spines to become associated with cadherin and to influence synaptic size and strength [118]. Adhesion molecules such as cadherin also associate with molecules that regulate cytoskeletal rearrangements, such as proteins that control the Rho GTPase pathway [119].

Adhesion molecules could therefore contribute to the morphological alteration and stabilization of connectivity between neurons, a process that is hypothesized to underlie memory consolidation. Consistent with this hypothesis is the role of adhesion molecules in the formation and stabilization of LTP and LTM. Integrin-mediated adhesion helps to stabilize early-phase LTP (E-LTP) into late-phase LTP (L-LTP). For example, inhibition of integrin with a peptide that contains the integrin recognition sequence 10 min before, immediately after and 10 min after LTP induction caused a gradual decay of synaptic strength over 40 min [120]. The peptide had no effect when applied 25 min after LTP initiation, indicating that integrin has a role in stabilization of synaptic connectivity. Furthermore, N-cadherin is synthesized and internalized to new assembled synapses during the induction of L-LTP, and blocking N-cadherin adhesion prevents the induction of L-LTP but not E-LTP [121]. This event depends on glutamate receptor activity. In chicks, memory is impaired 24 h after a visual categorization task when antibodies against the cell adhesion molecule L1 are injected before, 5.5 h or 15–18 h after training (but not later) [122]. In addition, intraventricular injection of antibodies against neural cell adhesion molecule (NCAM) in rats 6–8 h after passive avoidance training, but not later, impaired retention of the avoidance response [123]. These observations indicate that adhesion molecules are essential for memory consolidation during a period of hours after acquisition.

The level and distribution of adhesion molecules is also correlated with synaptic plasticity and learning. In Aplysia, repeated application of 5-hydroxytryptamine (serotonin; 5-HT), which leads to long-term facilitation of the sensory–motor connection, induces the internalization of the adhesion molecule apCAM (Aplysia cell adhesion molecule) [43]. This could destabilize the interaction between sensory neurons, permitting the growth of new sensory axons.ApCAM could be redistributed to the area where new synapses are formed. In rats, N-cadherin is induced in the piriform cortex and hypothalamus 2 h after fear conditioning [124]. N-cadherin was not induced in control animals that were presented with the conditioned stimulus and unconditioned stimulus in a non-associative manner.

On the whole, these observations indicate that adhesion molecules have a central role in mediating neuronal connectivity and morphogenesis, and in the progressive stabilization of synaptic connectivity that leads to memory consolidation. (LeDoux, 2004, pages 50-51)

I did some more digging and found that A3, A5, A8, and B1 (McGeachie, Cingolani, & Godaare, 2011) are all expressed in synaptic formation and function and in the growth and activity of dendrites. If the alpha versions of the integrins are not functioning properly, learning and memory are inhibited, but there are differences for each of the alpha integrins and for the beta integrin:

Interestingly, behavioural tests revealed specific deficits in hippocampal-dependent working memory, while spatial memory was unaffected. Although ITGβ1 is likely to be the major subunit for ITGα3, ITGα5 and ITGα8 in the hippocampus (Hynes, 2002), ITGα3/+;ITGα5/+;ITGα8/+ mice showed behavioural deficits (see above) that are different from those of ITGβ1 conditional knockout mice. Such divergent results may reflect the differences arising from global reduction in ITGα3, ITGα5 and ITGα8 versus a more specific ablation of ITGβ1 mainly in CA1 pyramidal neurons.

[In the quote above, ITGα3, and so on, is used to represent integrin (ITG) alpha 3.] 

Inflammation from Psychosocial Stress

We know that psychosocial stress causes inflammation. University of Arizona researcher/professor Charles Raison (2006) found that depressed patients have higher levels of proinflammatory cytokines, acute phase proteins, chemokines, and cellular adhesion molecules (an important finding for my thesis). It has also been shown that therapeutic administration of the cytokine interferon-α (a cancer treatment drug that inhibits tumor cell growth) leads to depression in up to 50% of patients (Bonaccorso, et al, 2002).

Stress appears to down-regulate immunity through at least three mechanisms:

(A) Stress hormones are influenced by negative events and negative emotions: catecholamines (adrenaline and noradrenaline), adrenocorticotropic hormone (ACTH), cortisol, growth hormone, and prolactin, as examples

(B) Immune modulation by these hormones proceeds through two pathways: 

1. Directly, through binding of the hormone to its cognate receptor at the surface of a cell 
2. Indirectly — for example, by inducing dysregulation of the production of cytokines, such as interferon-γ (IFN-γ), interleukin-1 (IL-1),IL-2,IL-6 and tumour-necrosis factor (TNF)

Cytokines such as IFN-γ have many functions and affect different target cells. Therefore, there are secondary effects of many stress hormones on the immune response

(C) Communication between the CNS and the immune system is bidirectional - examples: 

1. IL-1 influences the production of corticotropin-releasing hormone (CRH) by the hypothalamus. In turn, CRH can affect the HPA axis and thereby trigger increases in stress hormone levels, which results in dysregulation of immune function 
2. Lymphocytes can synthesize hormones such as ACTH, prolactin and growth hormone

Glaser, R., & Kiecolt-Glaser, J. K. (2005). Stress-induced immune dysfunction: implications for health. Nature Reviews Immunology, 5(3), 243-251.

Here is the abstract (edited for relevance) from an excellent review article: Psychosocial stress and inflammation in cancer by Powell, Tarr, and Sheridan (2013) that provides some useful information about how stress (i.e., trauma) can compromise the immune system. [Bold area is my emphasis.]

Stress-induced immune dysregulation results in significant health consequences for immune related disorders including viral infections, chronic autoimmune disease, and tumor growth and metastasis.  Both human and animal studies have shown the sympathetic and neuroendocrine responses to psychosocial stress significantly impacts cancer, in part, through regulation of inflammatory mediators. Psychosocial stressors stimulate neuroendocrine, sympathetic, and immune responses that result in the activation of the hypothalamic–pituitary–adrenal (HPA)-axis, sympathetic nervous system (SNS), and the subsequent regulation of inflammatory responses by immune cells. Social disruption (SDR) stress, a murine model of psychosocial stress and repeated social defeat, provides a novel and powerful tool to probe the mechanisms leading to stress-induced alterations in inflammation, tumor growth, progression, and metastasis.

The following is from the first section of the same paper and it provides an overview of the chemical pathways involved in stress-induced inflammation.

[S]tudies using a mouse model of repeated social defeat, termed social disruption (SDR) stress, have shown that stress alone can trigger the generation, egress, and trafficking of immature, inflammatory myeloid derived-cells that are glucocorticoid (GC) insensitive (Curry et al., 2010, Engler et al., 2004a and Engler et al., 2005). In addition, these GC insensitive cells produce high levels of IL-6 and other inflammatory cytokines and chemokines (Powell et al., 2009, Stark et al., 2002 and Wohleb et al., 2011). As a consequence, these stress-induced changes at the cellular level translate to significant immune (enhanced inflammatory responses and immunity to microbial, viral, and allergen challenge) and behavioral (prolonged anxiety-like behavior) changes (Bailey et al., 2007, Bailey et al., 2009b, Bailey et al., 2009a, Dong-Newsom et al., 2010, Kinsey et al., 2007, Mays et al., 2010, Mays et al., 2012, Powell et al., 2011 and Wohleb et al., 2011). Indicative of the important role of the SNS in stress-induced immune alteration, these changes are reversed by the blockade of sympathetic signaling prior to stressor exposure (Wohleb et al., 2011).

The stress response in vertebrates stems from internal or external stimuli that trigger the “fight or flight” and "defeat/withdrawal" responses expressed in sympathetic nervous system (SNS) and the hypothalamic–pituitary–adrenal (HPA)-axis activation. Years of research has shown that specific central nervous system (CNS) pathways function as translators of social stimuli into peripheral biological signals that regulate inflammatory responses.

For instance, stress activates neuroendocrine and autonomic pathways like the HPA axis, and the SNS resulting in the release of GC, catecholamines, and pro-inflammatory cytokines such as IL-1, IL-6, and TNF-α. The release of these sympathetic, neuroendocrine, and immune factors has a profound influence on immunity, behavior, and physiology in both humans and rodents and triggers peripheral biological responses that, in turn, signal back to the CNS to complete a bi-directional communication circuit. This is evident in models of repeated social defeat, like SDR, that enhance immune responses to microbial, viral, and allergic challenges and promote and prolong anxiety-like behavior in rodents (Kinsey et al., 2007, Bailey et al., 2009a, Bailey et al., 2009b and Mays et al., 2010). Social disruption stress-induced prolonged anxiety-like behavior coincides with a unique pattern of c-Fos activation in brain regions associated with fear and threat appraisal. For example, repeated social defeat, termed social disruption (SDR) causes increased c-Fos activation in the prefrontal cortex, amygdala, hippocampus, paraventricular nucleus, bed nucleus of the stria terminalis and the lateral septum (Wohleb et al., 2011). [Powell, Tarr, and Sheridan, 2013, p. 3]

When the HPA and SNS circuitry are activated, the release of neurotransmitters and stress hormones generates compensatory physiologic changes that impact behavior and the function of the immune system. In humans, chronic or repeated exposure to stress appears to lead to increases in the expression of inflammatory biomarkers, worsened disease states, and affective/emotional disorders (Glaser and Kiecolt-Glaser, 2005; Gouin et al., 2012).

In several studies, stressed individuals exhibit reduced anti-inflammatory glucocorticoid regulation and increased inflammatory nuclear factor (NF)-κB signaling (Miller et al., 2008). In these situations, psychosocial stress represents a challenge to homeostasis that manifests as physiological alterations in the body (Glaser and Kiecolt-Glaser, 2005).

This may be something to look at in terms of how trauma impacts the brain and body, a microbiological model of traumatic stress, inflammation, and the alteration of adhesion molecules, all of which leads to impaired learning and impaired memory.

As of now, there are no known interventions at the cellular level for altering integrin function. However, the are many ways to control and eliminate inflammation. Among the most well-researched (I could provide citations for these, but it's late, so I might add them later):

1) Curcumin/turmeric
2) Resveratrol
3) Exercise
4) Stress-reduction techniques, such as meditation
5) Avoiding smoking, drinking, and processed foods

We have some control over how our bodies manage and adapt to stress. We are not merely victims of our biology.

The Evolutionary Role of the Freeze Response in Trauma

One of the biggest challenges in working with survivors of sexual trauma is the client's sense of failure if, during the course of the assault or rape, s/he froze and did not fight or run. The client feels s/he failed to do what s/he "should" have done, or could have done, to fight off or run from the perpetrator.

Of course, we know this is not true. And we might try to help the client understand that any response that kept him/her alive is the right response. Often these attempts to reframe the situation fall on deaf ears.

However, I have found that offering a biological and evolutionary explanation seems to carry a little more weight. Below is one of the best explanations of the neurobiology of the freeze response, courtesy of Joseph LeDoux.

"[F]reezing is a beneficial response when faced with a predator. Predators, primal danger for most animals, respond to and are excited by movement. Keeping still in the face of danger is often the best thing for the prey to do. Because millions of years ago animals who did so were more likely to survive, today it's what most animals do, at least as an initial line of defense. Freezing is not a choice but an automatic response, a preprogrammed way of dealing with danger."

"What's interesting is that freezing also occurs if a rat (or other animal) clearly hears a sound that preceded an aversive stimulus (a mild electrical shock of its feet) on some prior occasion. There's no predator around in this case, so how is the connection formed? The sound is a warning signal. Any rat that survives an encounter with a cat or other predator should store in its brain as much about the situation as possible so that the next time the sounds, sights, or smells that preceded the arrival of the cat occur, those stimuli can be attended to in order to increase its chances of staying alive."

~ Joseph LeDoux, Synaptic Self: How Our Brains Become Who We Are, 2002, p. 6

Dr. Bessel van der Kolk is not only one of the main figures in the treatment of trauma and traumatic stress, he was one of the architects of the post-traumatic stress disorder (PTSD) diagnosis. Before the return of soldiers from the Vietnam War, PTSD was often seen as cowardice, battle fatigue, or shell shock.

When the then young Dr. van der Kolk began treating returning soldiers at a VA hospital with pharmacological interventions, he quickly realized these drugs - as powerful as they were - could not touch the trauma these men (and some women) were experiencing.

For nearly a decade (late 1970s and into the 1980s), PTSD was seen primarily as a battle related disorder (a fact that allowed the military, until quite recently, to discharge the victims of sexual assault within the ranks with a diagnosis of a personality disorder). However, due to Dr. van der Kolk, Dr, Judith Herman, and others, the diagnosis began to be applied to ANY form of trauma that presents the survivor with witnessing or experiencing a threat of severe bodily harm and/or death.

If it were not for Dr. van der Kolk and others in his generation of psychiatrists and psychologists, there would not be a sexual trauma field and I would not be doing the work I am doing.

Shrink Rap Radio #436 – Brain, Mind, and Body in The Healing of Trauma with Bessel van der Kolk MD

A psychology podcast by David Van Nuys, Ph.D.
copyright 2014: David Van Nuys, Ph.D.

Podcast: Play in new window | Download

Posted on January 1, 2015

Bessel van der Kolk, MD is a world renowned researcher and clinician in the field of traumatic stress. His innovative work to integrate mind, brain, body, and social connections in the healing of trauma has had a profound impact on the care and treatment of trauma victims all over the world. Dr. van der Kolk’s research includes brain imaging studies on trauma’s impact on childhood development and the effects of therapies such as yoga, neurofeedback, EMDR, theater and movement on traumatic stress. Dr. van der Kolk, a professor in the department of psychiatry at Boston University Medical School, is the founder and medical director of the Trauma Center in Boston and the director of the National Child Traumatic Stress Network (NCTSN), established by Congress to raise the standard of care and improve access to services for traumatized children, their families and communities. Dr. van der Kolk’s newest book, The Body Keeps The Score: Brain, Mind and Body in the Healing of Trauma (Viking, 2014)—a New York Times Best Seller—offers a sweeping and revolutionary new understanding of the causes and consequences of trauma and how to heal the traumatized brain.

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Best Psychology & Neuroscience Books of 2014 (according to me)

Here are some of the best books I have been exposed to this year. Obviously, I cannot read everything, so this is a partial list at best. They are listed in alphabetical order. Descriptive text is from the publisher's blurb on Amazon.

A few of these books warrant the RECOMMENDED READ classification.

Adult Attachment Patterns in a Treatment Context: Relationship and Narrative

Sarah Daniel

Attachment theory posits that the need for attachment is a life-long phenomenon that becomes especially relevant in times of crisis or trauma. When adults experience illness, accidents, assaults, psychological difficulties or losses, their attachment-behavioural systems are activated, motivating them to seek help and support from family and friends and/or from helping professionals. However, the resulting request for help is affected and shaped by earlier experiences regarding the support and trustworthiness of attachment figures. Can others be trusted? Is it safe to show vulnerability? How should one behave to increase the likelihood of receiving the help needed? 

Adult Attachment Patterns in a Treatment Context provides an integrated introduction to the subject of adult attachment. Research into adult attachment patterns offers professional helpers a theoretically sound insight into the dynamics underlying a range of client behaviours, including some of the more puzzling and frustrating behaviours such as denying obvious pain or continually pushing the professional for more personal involvement. Sarah Daniel shows how applying knowledge of attachment patterns to treatment settings will improve the way in which professionals engage with clients and the organization of treatments. This book will be relevant to a range of helping professionals such as psychotherapists, psychologists and social workers, both in practice and in training.

Affect Regulation Training: A Practitioners' Manual

Matthias Berking and Brian Whitley 

Emotion Regulation is currently one of the most popular topics in clinical psychology. Numerous studies demonstrate that deficits in emotion regulation skills are likely to help maintain various forms of psychological disorders. Thus, enhancing emotion regulation has become a major target in psychotherapeutic treatments. For this purpose, a number of therapeutic strategies have been developed and shown to be effective. However, for practitioners it is often difficult to decide which of these strategies they should use or how they can effectively combine empirically-validated strategies. Thus, the authors developed the Affect Regulation Training as a transdiagnostic intervention which systematically integrates strategies from cognitive behavior therapy, mindfulness-based interventions, emotion-focused therapy, and dialectical behavioral therapy. The effectiveness of ART has been demonstrated in several high-quality studies. 

Attachment and Interaction: From Bowlby to Current Clinical Theory and Practice

Mario Marrone

Attachment and Interaction is an accessible introduction to the history and evolution of attachment theory, which traces the early roots of attachment theory from the work of its creator John Bowlby through to the most recent theoretical developments and their clinical applications. Mario Marrone explores how attachment theory can inform how therapists work with their patients, and what the practical implications are of using such an approach. By mixing personal anecdotes from his own experiences as Bowlby's supervisee with clear explanations of Bowlby's ideas and how they have evolved, Marrone creates a memorable and engaging account of attachment theory. This new, updated edition includes new material on bereavement, sexuality and the application of attachment-based principles to individual, family and group psychotherapy. This clear exposition of attachment theory is relevant and valuable reading for trainee and practising individual and group psychotherapists, family therapists and mental health professionals - as well as anyone with an interest in John Bowlby and the evolution of psychotherapy.

The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

Bessel A. van der Kolk 

RECOMMENDED READ.

A pioneering researcher and one of the world’s foremost experts on traumatic stress offers a bold new paradigm for healing

Trauma is a fact of life. Veterans and their families deal with the painful aftermath of combat; one in five Americans has been molested; one in four grew up with alcoholics; one in three couples have engaged in physical violence. Such experiences inevitably leave traces on minds, emotions, and even on biology. Sadly, trauma sufferers frequently pass on their stress to their partners and children.

Renowned trauma expert Bessel van der Kolk has spent over three decades working with survivors. In The Body Keeps the Score, he transforms our understanding of traumatic stress, revealing how it literally rearranges the brain’s wiring—specifically areas dedicated to pleasure, engagement, control, and trust. He shows how these areas can be reactivated through innovative treatments including neurofeedback, mindfulness techniques, play, yoga, and other therapies. Based on Dr. van der Kolk’s own research and that of other leading specialists, The Body Keeps the Score offers proven alternatives to drugs and talk therapy—and a way to reclaim lives.

Brain, Mind, and Consciousness in the History of Neuroscience

C.U.M. Smith and Harry Whitaker, Editors

This volume of essays examines the problem of mind, looking at how the problem has appeared to neuroscientists (in the widest sense) from classical antiquity through to contemporary times. Beginning with a look at ventricular neuropsychology in antiquity, this book goes on to look at Spinozan ideas on the links between mind and body, Thomas Willis and the foundation of Neurology, Hooke’s mechanical model of the mind and Joseph Priestley’s approach to the mind-body problem.

The volume offers a chapter on the 19th century Ottoman perspective on western thinking. Further chapters trace the work of nineteenth century scholars including George Henry Lewes, Herbert Spencer and Emil du Bois-Reymond. The book covers significant work from the twentieth century, including an examination of Alfred North Whitehead and the history of consciousness, and particular attention is given to the development of quantum consciousness. Chapters on slavery and the self and the development of an understanding of Dualism bring this examination up to date on the latest 21st century work in the field.

At the heart of this book is the matter of how we define the problem of consciousness itself: has there been any progress in our understanding of the working of mind and brain? This work at the interface between science and the humanities will appeal to experts from across many fields who wish to develop their understanding of the problem of consciousness, including scholars of Neuroscience, Behavioural Science and the History of Science.

Cyclical Psychodynamics and the Contextual Self: The Inner World, the Intimate World, and the World of Culture and Society

Paul L. Wachtel

Cyclical Psychodynamics and the Contextual Self articulates in new ways the essential features and most recent extensions of Paul Wachtel's powerfully integrative theory of cyclical psychodynamics. Wachtel is widely regarded as the leading advocate for integrative thinking in personality theory and the theory and practice of psychotherapy. He is a contributor to cutting edge thought in the realm of relational psychoanalysis and to highlighting the ways in which the relational point of view provides especially fertile ground for integrating psychoanalytic insights with the ideas and methods of other theoretical and therapeutic orientations. 

In this book, Wachtel extends his integration of psychoanalytic, cognitive-behavioral, systemic, and experiential viewpoints to examine closely the nature of the inner world of subjectivity, its relation to the transactional world of daily life experiences, and the impact on both the larger social and cultural forces that both shape and are shaped by individual experience. Here, he discusses in a uniquely comprehensive fashioning the subtleties of the clinical interaction, the findings of systematic research, and the role of social, economic, and historical forces in our lives. The chapters in this book help to transcend the tunnel vision that can lead therapists of different orientations to ignore the important discoveries and innovations from competing approaches. 

Explicating the pervasive role of vicious circles and self-fulfilling prophecies in our lives, Cyclical Psychodynamics and the Contextual Self shows how deeply intertwined the subjective, the intersubjective, and the cultural realms are, and points to new pathways to therapeutic and social change. Both a theoretical tour de force and an immensely practical guide to clinical practice, this book will be essential reading for psychoanalysts, psychotherapists and students of human behavior of all backgrounds and theoretical orientations.

The Future of the Brain: Essays by the World's Leading Neuroscientists

Gary Marcus and Jeremy Freeman, Editors

Including a chapter by 2014 Nobel laureates May-Britt Moser and Edvard Moser 

An unprecedented look at the quest to unravel the mysteries of the human brain, The Future of the Brain takes readers to the absolute frontiers of science. Original essays by leading researchers such as Christof Koch, George Church, Olaf Sporns, and May-Britt and Edvard Moser describe the spectacular technological advances that will enable us to map the more than eighty-five billion neurons in the brain, as well as the challenges that lie ahead in understanding the anticipated deluge of data and the prospects for building working simulations of the human brain. A must-read for anyone trying to understand ambitious new research programs such as the Obama administration's BRAIN Initiative and the European Union's Human Brain Project, The Future of the Brain sheds light on the breathtaking implications of brain science for medicine, psychiatry, and even human consciousness itself.

Contributors include: Misha Ahrens, Ned Block, Matteo Carandini, George Church, John Donoghue, Chris Eliasmith, Simon Fisher, Mike Hawrylycz, Sean Hill, Christof Koch, Leah Krubitzer, Michel Maharbiz, Kevin Mitchell, Edvard Moser, May-Britt Moser, David Poeppel, Krishna Shenoy, Olaf Sporns, Anthony Zador.

The Future of the Mind: The Scientific Quest to Understand, Enhance, and Empower the Mind

Michio Kaku 

I included this book because it is representative of the state of the science in (mis)understanding the mind. I disagree with several of the basic (reductionist) premises Kaku takes as givens.

The New York Times best-selling author of PHYSICS OF THE IMPOSSIBLE, PHYSICS OF THE FUTURE and HYPERSPACE tackles the most fascinating and complex object in the known universe: the human brain.
For the first time in history, the secrets of the living brain are being revealed by a battery of high tech brain scans devised by physicists. Now what was once solely the province of science fiction has become a startling reality. Recording memories, telepathy, videotaping our dreams, mind control, avatars, and telekinesis are not only possible; they already exist.

THE FUTURE OF THE MIND gives us an authoritative and compelling look at the astonishing research being done in top laboratories around the world—all based on the latest advancements in neuroscience and physics.  One day we might have a "smart pill" that can enhance our cognition; be able to upload our brain to a computer, neuron for neuron; send thoughts and emotions around the world on a "brain-net"; control computers and robots with our mind; push the very limits of immortality; and perhaps even send our consciousness across the universe.

Dr. Kaku takes us on a grand tour of what the future might hold, giving us not only a solid sense of how the brain functions but also how these technologies will change our daily lives. He even presents a radically new way to think about "consciousness" and applies it to provide fresh insight into mental illness, artificial intelligence and alien consciousness. 

With Dr. Kaku's deep understanding of modern science and keen eye for future developments, THE FUTURE OF THE MIND is a scientific tour de force--an extraordinary, mind-boggling exploration of the frontiers of neuroscience.

Manifesting minds: A Review of Psychedelics in Science, Medicine, Sex, and Spirituality

Rick Doblin, PhD, and Brad Burge, Editors

Featuring essays and interviews with Timothy Leary, Aldous Huxley, Ram Dass, Albert Hofmann, Alexander (Sasha) Shulgin, Daniel Pinchbeck, Tim Robbins, Arne Naess, and electronic musician Simon Posford, as well as groundbreaking research and personal accounts, this one-of-a-kind anthology is a "best of" collection of articles and essays published by the Multidisciplinary Association for Psychedelic Studies (MAPS). Topics include the healing use of marijuana and psychedelics--including MDMA, ibogaine, LSD, and ayahuasca--for PTSD, anxiety, depression, and drug addiction, as well as positive effects of these substances in the realm of the arts, family, spirituality, ecology, and technology.

Among many other thought-provoking and mind-opening pieces are the following:
• "On Leary and Drugs at the End," by Carol Rosen and Vicki Marshall
• "Psychedelic Rites of Passage," by Ram Dass
• "To Be Read at the Funeral," by Albert Hofmann
• "Another Green World: Psychedelics and Ecology," by Daniel Pinchbeck
• "Psychedelics and Species Connectedness," by Stanley Krippner, PhD
• "Huxley on Drugs and Creativity," by Aldous Huxley
• "Psychedelics and the Deep Ecology Movement: A Conversation with Arne Naess," by Mark A. Schroll, PhD, and David Rothenberg
• "Psychedelic Sensibility," by Tom Robbins
• "Electronic Music and Psychedelics: An Interview with Simon Posford of Shpongle," by David Jay Brown
• "How Psychedelics Informed My Sex Life and Sex Work," by Annie Sprinkle
• "Consideration of Ayahuasca for the Treatment of Posttraumatic Stress Disorder," by Jessica Nielson, PhD, and Julie Megler, MSN, NP-BC
• "Psychedelics and Extreme Sports," by James Oroc
• "Youth and Entheogens: A Modern Rite of Passage?," by Andrei Foldes with Amba, Eric Johnson, et al.
• "Diary of an MDMA Subject," by Anonymous
• "Dimethyltryptamine: Possible Endogenous Ligand of the Sigma-1 Receptor?," by Adam L. Halberstadt
• "Lessons from Psychedelic Therapy," by Richard Yensen, PhD
• "Psychosomatic Medicine, Psychoneuroimmunology, and Psychedelics," by Ana Maqueda
• "Talking with Ann and Sasha Shulgin about the Existence of God and the Pleasures of Sex and Drugs," by Jon Hanna and Silvia Thyssen

Memory Development from Early Childhood Through Emerging Adulthood

Wolfgang Schneider

Based on decades of established research findings in cognitive and developmental psychology, this volume explores and integrates the leading scientific advances into infancy and brain-memory linkages as well as autobiographical and strategic memory. In addition, given that the predominantly classic research on memory development has recently been complemented by more cutting-edge applied research (e.g., eyewitness memory, memory development in educational contexts) in recent years, this volume also provides in-depth and up-to-date coverage of these emerging areas of study.

Metacognition: Fundaments, Applications, and Trends - A Profile of the Current State-Of-The-Art

Alejandro Peña-Ayala, Editor

This book is devoted to the Metacognition arena. It highlights works that show relevant analysis, reviews, theoretical, and methodological proposals, as well as studies, approaches, applications, and tools that shape current state, define trends and inspire future research. As a result of the revision process fourteen manuscripts were accepted and organized into five parts as follows:

· Conceptual: contains conceptual works oriented to: (1) review models of strategy instruction and tailor a hybrid strategy; (2) unveil second-order judgments and define a method to assess metacognitive judgments; (3) introduces a conceptual model to describe the metacognitive activity as an autopoietic system.

· Framework: offers three works concerned with: (4) stimulate metacognitive skills and self-regulatory functions; (5) evaluate metacognitive skills and self-regulated learning at problem solving; (6) deal with executive management metacognition and strategic knowledge metacognition.

· Studies: reports research related to: (7) uncover how metacognitive awareness of listening strategies bias listening proficiency; (8) unveil how metacognitive skills and motivation are achieved in science informal learning; (9) tackle stress at learning by means of coping strategies.

· Approaches: focus on the following targets: (10) social metacognition to support collaborative problem solving; (11) metacognitive skills to be stimulated in computer supported collaborative learning; (12) metacognitive knowledge and metacognitive experiences are essential for teaching practices. 

· Tools: promotes the use of intelligent tutoring systems such as: (13) BioWorld allows learners to practice medical diagnostic by providing virtual patient cases; (14) MetaHistoReasoning provides examples to learners and inquiries about the causes of historical events.

This volume will be a source of interest for researchers, practitioners, professors, and postgraduate students aimed at updating their knowledge and finding targets for future work in the metacognition arena.

The Myth of Mirror Neurons: The Real Neuroscience of Communication and Cognition

Gregory Hickok, PhD

RECOMMENDED READ.

An essential reconsideration of one of the most far-reaching theories in modern neuroscience and psychology.

In 1992, a group of neuroscientists from Parma, Italy, reported a new class of brain cells discovered in the motor cortex of the macaque monkey. These cells, later dubbed mirror neurons, responded equally well during the monkey’s own motor actions, such as grabbing an object, and while the monkey watched someone else perform similar motor actions. Researchers speculated that the neurons allowed the monkey to understand others by simulating their actions in its own brain. 

Mirror neurons soon jumped species and took human neuroscience and psychology by storm. In the late 1990s theorists showed how the cells provided an elegantly simple new way to explain the evolution of language, the development of human empathy, and the neural foundation of autism. In the years that followed, a stream of scientific studies implicated mirror neurons in everything from schizophrenia and drug abuse to sexual orientation and contagious yawning.

In The Myth of Mirror Neurons, neuroscientist Gregory Hickok reexamines the mirror neuron story and finds that it is built on a tenuous foundation—a pair of codependent assumptions about mirror neuron activity and human understanding. Drawing on a broad range of observations from work on animal behavior, modern neuroimaging, neurological disorders, and more, Hickok argues that the foundational assumptions fall flat in light of the facts. He then explores alternative explanations of mirror neuron function while illuminating crucial questions about human cognition and brain function: Why do humans imitate so prodigiously? How different are the left and right hemispheres of the brain? Why do we have two visual systems? Do we need to be able to talk to understand speech? What’s going wrong in autism? Can humans read minds?

The Myth of Mirror Neurons not only delivers an instructive tale about the course of scientific progress—from discovery to theory to revision—but also provides deep insights into the organization and function of the human brain and the nature of communication and cognition.

Neuronal Dynamics: From Single Neurons to Networks and Models of Cognition

Wulfram Gerstner, Werner M . Kistler, Richard Naud, Liam Paninski

What happens in our brain when we make a decision? What triggers a neuron to send out a signal? What is the neural code? This textbook for advanced undergraduate and beginning graduate students provides a thorough and up-to-date introduction to the fields of computational and theoretical neuroscience. It covers classical topics, including the Hodgkin-Huxley equations and Hopfield model, as well as modern developments in the field such as Generalized Linear Models and decision theory. Concepts are introduced using clear step-by-step explanations suitable for readers with only a basic knowledge of differential equations and probabilities, and are richly illustrated by figures and worked-out examples. End-of-chapter summaries and classroom-tested exercises make the book ideal for courses or for self-study. The authors also give pointers to the literature and an extensive bibliography, which will prove invaluable to readers interested in further study.

The Feeling Body: Affective Science Meets the Enactive Mind

Giovanna Colombetti

RECOMMENDED READ.

In The Feeling Body, Giovanna Colombetti takes ideas from the enactive approach developed over the last twenty years in cognitive science and philosophy of mind and applies them for the first time to affective science -- the study of emotions, moods, and feelings. She argues that enactivism entails a view of cognition as not just embodied but also intrinsically affective, and she elaborates on the implications of this claim for the study of emotion in psychology and neuroscience. 

In the course of her discussion, Colombetti focuses on long-debated issues in affective science, including the notion of basic emotions, the nature of appraisal and its relationship to bodily arousal, the place of bodily feelings in emotion experience, the neurophysiological study of emotion experience, and the bodily nature of our encounters with others. Drawing on enactivist tools such as dynamical systems theory, the notion of the lived body, neurophenomenology, and phenomenological accounts of empathy, Colombetti advances a novel approach to these traditional issues that does justice to their complexity. Doing so, she also expands the enactive approach into a further domain of inquiry, one that has more generally been neglected by the embodied-embedded approach in the philosophy of cognitive science.

The Origins of Attachment: Infant Research and Adult Treatment

Beatrice Beebe and Frank M. Lachmann

Technically, this book came out at the end of 2013, but I am including it anyway because it is a RECOMMENDED READ, especially for therapists (according to me).

The Origins of Attachment: Infant Research and Adult Treatment addresses the origins of attachment in mother-infant face-to-face communication. New patterns of relational disturbance in infancy are described. These aspects of communication are out of conscious awareness. They provide clinicians with new ways of thinking about infancy, and about nonverbal communication in adult treatment.
Utilizing an extraordinarily detailed microanalysis of videotaped mother-infant interactions at 4 months, Beatrice Beebe, Frank Lachmann, and their research collaborators provide a more fine-grained and precise description of the process of attachment transmission. Second-by-second microanalysis operates like a social microscope and reveals more than can be grasped with the naked eye.

The book explores how, alongside linguistic content, the bodily aspect of communication is an essential component of the capacity to communicate and understand emotion. The moment-to-moment self- and interactive processes of relatedness documented in infant research form the bedrock of adult face-to-face communication and provide the background fabric for the verbal narrative in the foreground.


The Origins of Attachment is illustrated throughout with several case vignettes of adult treatment. Discussions by Carolyn Clement, Malcolm Slavin and E. Joyce Klein, Estelle Shane, Alexandra Harrison and Stephen Seligman show how the research can be used by practicing clinicians. This book details aspects of bodily communication between mothers and infants that will provide useful analogies for therapists of adults. It will be essential reading for psychoanalysts, psychotherapists and graduate students.

Collaborators Joseph Jaffe, Sara Markese, Karen A. Buck, Henian Chen, Patricia Cohen, Lorraine Bahrick, Howard Andrews, Stanley Feldstein

Discussants Carolyn Clement, Malcolm Slavin, E. Joyce Klein, Estelle Shane, Alexandra Harrison, Stephen Seligman

The Therapeutic Use of Ayahuasca

Beatriz Caiuby Labate and Clancy Cavnar, Editors

This book also came out at the end of 2013, but it is an important collection of articles on a topic that has been taboo in academic circles for far too long.

This book presents a series of perspectives on the therapeutic potential of the ritual and clinical use of the Amazonian hallucinogenic brew ayahuasca in the treatment and management of various diseases and ailments, especially its role in psychological well-being and substance dependence. Biomedical and anthropological data on the use of ayahuasca for treating depression, PTSD, and substance dependence in different settings, such as indigenous contexts, neo-shamanic rituals, contemporary therapeutic circles, and in ayahuasca religions, in both South and North America, are presented and critiqued. Though multiple anecdotal reports on the therapeutic use of ayahuasca exist, there has been no systematic and dense reflection on the topic thus far. The book brings the therapeutic use of ayahuasca to a new level of public examination and academic debate. The texts in this volume stimulate discussion on methodological, ethical, and political aspects of research and will enhance the development of this emergent field of studies.

Understanding Psychosis and Schizophrenia: Why People Sometimes Hear Voices, Believe Things that Others Find Strange, or Appear Out of Touch with Reality, and What Can Help

Edited by Anne Cooke

A report by the Division of Clinical Psychology (BPS)

RECOMMENDED READ. This is an important new book in that the authors have taken a client-centered, relational perspective on psychosis, one of the most misunderstood and stigmatized psychological adaptations to trauma. And it's FREE to download.

Understanding Psychosis and Schizophrenia: Why people sometimes hear voices, believe things that others find strange, or appear out of touch with reality, and what can help has been written by a group of eminent clinical psychologists drawn from eight universities and six NHS trusts, together with people who have themselves experienced psychosis. 

It provides an accessible overview of the current state of knowledge, and its conclusions have profound implications both for the way we understand ‘mental illness’ and for the future of mental health services. 

Many people believe that schizophrenia is a frightening brain disease that makes people unpredictable and potentially violent, and can only be controlled by medication.  However research conducted over the last 20 years and brought together in this report reveals that this view is false. Rather:

• The problems we think of as ‘psychosis’ – hearing voices, believing things that others find strange, or appearing out of touch with reality – can be understood in the same way as other psychological problems such as anxiety or shyness.
• They are often a reaction to trauma or adversity of some kind which impacts on the way we experience and interpret the world.
• They rarely lead to violence.
• No one can tell for sure what has caused a particular person’s problems. The only way is to sit down with them and try and work it out.
• Services should not insist that people see themselves as ill.  Some prefer to think of their problems as, for example, an aspect of their personality which sometimes gets them into trouble but which they would not want to be without.
• We need to invest much more in prevention by attending to inequality and child maltreatment.  Concentrating resources only on treating existing problems is like mopping the floor while the tap is still running.

I have long felt that psychosis is more adequately understood when it is seen as the most extreme form of dissociation - a need so intense that it is not the body, or emotions, or memories that are dissociated, it is reality itself.

Although it is reality that is dissociated (through delusions, hallucinations, paranoia, and cognitive distortions), it is fundamentally the emotions that are most important in making sense of the psychotic features and in bringing the client back. I have no doubt that meds are important for some, but not everyone benefits from the psychological numbing effects of the atypical antipsychotics.

What my clients have taught me is that the key to recover is to reclaim the body, and with it the emotions that are so painful the person needed to create a different reality, where the client is often a different person, with different origins, and who is much more important in some ways than they ever were in their "normal" life.

This is a free article (until the end of December) from the International Forum of Psychoanalysis in which Lawrence Kirshner offers a psychoanalytic take on psychosis and its roots in trauma (follow the links to read online or download).

Full Citation:
Kirshner, L.A. (2013, Jun 4). Trauma and psychosis: A review and framework for psychoanalytic
understanding. International Forum of Psychoanalysis, DOI: 10.1080/0803706X.2013.778422

Trauma and psychosis: A review and framework for psychoanalytic understanding

Lewis A. Kirshner

• Published online: 04 Jun 2013

Abstract

Empirical research substantiates Ferenczi's conception of the etiological importance of early neglect and abuse in the development of psychosis. Abuse can derail the development of language, identity, and social relationships that are intrinsic to schizophrenia, possibly through undermining secure attachment relationships. The Lacanian emphasis on language and early proto-dialogues with the Other can be useful in understanding this process. Some therapeutic implications for psychoanalytic approaches to the treatment of psychosis are proposed.

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 Here is a bit from a section further down in the article.

Development of language, the symbolic, and attachment

 

To understand how trauma and neglect may result in schizophrenic disorders, we need to connect the typical deficits and symptoms of psychosis with developmental processes. The importance of access to language seems a promising avenue, as positive symptoms in schizophrenia are only identified and reported as speech or thoughts, and the ability to use relationships with others to modulate traumatic experience or to act as a barrier to it depends on the use of semiotic functions. Within psychoanalysis, Lacan was perhaps the most important theorist to hypothesize an inability to use language as the source of psychotic symptoms, notably as the basis for hallucinations and delusions, which are language-dependent entities (see Sauvagnat, 2003, and Vanheule, 2011, for discussions of this model). Of course, the concept of a thought disorder (in fact, a speech disorder) has been a basic feature of schizophrenia since Bleuler's work, and, recalling Crow's hypotheses, subjectivity depending on speech may be our key species characteristic, closely related to important developmental concepts such as theory of mind and intersubjectivity that have also been linked to schizophrenia (Lysaker, Outcault, & Ringer, 2010).

 

And this is from a later section.

 

Treatment issues

 

Research by Karon and Bos (cited in Ver Eecke, 2003) found that experienced clinicians were more successful with schizophrenic inpatients, especially over longer time periods. One explanation for this result may be the greater ability of experienced therapists to build a relationship with psychotic patients, which can take a long time. In general psychiatry, there is a growing recognition that individually designed approaches to treatment can be quite helpful (Mojtibai et al., 1998; Shean, 2009), suggesting the uniqueness of each therapeutic couple's construction of basic communication links. The difficulty of building alliance and trust with psychotic subjects has been emphasized by many psychoanalytic practitioners and suggests why the application of classic forms of analytic treatment may be misguided.

 

The focus of psychoanalysis on the individual subject, however, does provide the cornerstone of a psychotherapeutic approach, although the techniques of treatment may be far from traditional models (e.g., Abensour, 2008; Benedetti, 2011; Lucas, 2009). The psychotic is a person, a subject like anyone, but his subjectivity may take unusual and cryptic forms that can discourage clinicians from pursuing a treatment relationship. Lacan (1993) wrote in a late seminar about helping psychotics to ground their subjectivity through creative processes, making something new that establishes their identity through an object. In a similar approach, Abensour (2011) described how creative writing served as a kind of anchor in reality for many of her patients who suffered from the dilemma of a floating self, disconnected from the body, a past history, and relationships with others. Creative products acquire a real existence in time (like the transitional object) that can confirm the continuity of the subject and express its inner states.